title: Suicide attempt by complete self-removal of a 12-year-old permanent pacemaker system: case report.
abstract: BACKGROUND
  Psychological adaption after pacemaker implantation can be challenging in patients with psychiatric disease. Suicide by self-removal of a permanent pacemaker system is a rare phenomenon described in a few cases in patients with psychiatric disorders.
  
  
  RESULTS
  We describe a case of attempted suicide by complete self-removal of a 12-year-old permanent pacemaker system in a 70-year-old male patient with a bipolar disorder and a history of previous suicide attempts.
  
  
  CONCLUSIONS
  Suicide attempt by self-removal of a permanent pacemaker system is very rare. In patients with a history of psychiatric disease and previous suicide attempts, careful information about the function of a pacemaker should be given.
authors.affiliation: Department of Cardiology, Roskilde University Hospital, Roskilde, Denmark.
authors.forename: Mette Lykke
authors.initials: ML
authors.lastname: Norgaard
authors.forename: Thomas
authors.initials: T
authors.lastname: Melchior
authors.forename: Thomas
authors.initials: T
authors.lastname: Wagner
authors.forename: Ketil
authors.initials: K
authors.lastname: Haugan
mesh_terms: D000368:Aged; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology; D020878:Device Removal / Q000009:adverse effects / Q000379:methods / Q000523:psychology*; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D013406:Suicide, Attempted / Q000523:psychology*; D013997:Time Factors
keywords: bipolar disorder; pacemaker; suicide attempt; twiddler syndrome